INTESTINAL COLONIZATION WITH EXTENDED-SPECTRUM β-LACTAMASE PRODUCING ENTEROBACTERIACEAE IN PATIENTS WITH ACUTE MYELOID LEUKAEMIA AND LYMPHOMA

The aim of this study was to determine the prevalence and risk factors of intestinal colonization with extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-E) in patients with acute myeloid leukaemia (AML) and lymphoma.
Material and methods. 98 patients (median age of 43 years; 33 – AML, 65 – lymphoma) were included in the prospective study. Follow-up period was lasted for 6 months. Rectal swabs were collected within 2 days of admission and every 7 days further. Presence of ESBL was confirmed by phenotypic tests, genes bla^TEM and bla^CTX-M were detected by PCR. A total of 88 ESBL-E were isolated in 75 (76.5%) patients.
Results. Genes bla^CTX-M were detected in 69% of isolates, bla^TEM – in 49%, both genes – in 36%. Probability of intestinal colonization with ESBL-E was 91% in patients with lymphoma and 84% - in AML. Probability of persistent ESBL-E carriage was 30.3%. Recurrence of ESBL-E carriage was in 13 (39%) of 33 patients with a median of 37 days. Probability of recurrent ESBL-E colonization was 49.4%. Risk factors for ESBL-E carriage proved to be parenteral nutrition (p = 0.05) and permanent hospital stay (p = 0.002). The median of permanent hospital stay in these patients was 70 days (64–180 days). The rate of ESBL-E bacteremia in patients colonized with subsequent microorganisms was 7% (5/75). No bacteremia cases were in patients without colonization. Patients with AML and lymphoma underwent chemotherapy had a high risk of ESBL-E intestinal colonization. The presence of ESBL carriage was not permanent in all patients for 6 months. ESBL colonization should be considered in choosing antibiotics for prophylaxis and empirical approaches in patients with febrile neutropenia.

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